Antiphospholipid Syndrome

The answer first

Antiphospholipid syndrome (APS) is a systemic autoimmune thrombophilia defined by the persistent presence of antiphospholipid antibodies together with vascular thrombosis or pregnancy morbidity. The disease is the most common acquired thrombophilia and an examiner favourite because it sits at the intersection of rheumatology, haematology, obstetric medicine, neurology and nephrology. The treating physician's job is to recognise the syndrome, confirm the antibodies, stratify thrombotic and obstetric risk, and deliver a sequenced anticoagulation plan that accounts for recurrent events, pregnancy and the catastrophic variant. ^{[1] [6]}

The FRACP candidate must defend three positions without hedging: (1) APS is a clinical-laboratory syndrome requiring persistence of antibodies at least 12 weeks apart; (2) warfarin remains the oral anticoagulant of choice for most patients with thrombotic APS, because direct oral anticoagulants underperformed in high-risk cohorts; and (3) pregnancy morbidity is treated with combination low-dose aspirin plus low-molecular-weight heparin, not warfarin, which is teratogenic. Lead with the decision, then the evidence, then the trap. ^{[13] [14] [15]}

References11ShowHide

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8. [12]Grossi C, Bodio C, Kumar S, Bison E, et al. Correction: Anti-β2GPI IgG display a broad reactivity against different β2GPI domains beyond domain 1: results from the APS ACTION and multi-center Italian cohorts Front Immunol, 2026.PMID 42273675
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11. [15]Tektonidou MG, Andreoli L, Limper M, et al. EULAR recommendations for the management of antiphospholipid syndrome in adults Ann Rheum Dis, 2019.PMID 31092409